"重返社区技能训练"对精神分裂症康复的作用

目的 :探讨重返社区技能训练对缓解社区精神分裂症患者的精神症状和改善其社会功能方面的作用。方法 :将 5 0例非急性期的社区精神分裂症患者随机分为技能训练组 (以下简称训练组 ;2 5例 )和对照组 (2 5例 ,其中脱落 2例 )。对技能训练组进行技能训练共 4周 ,然后随访 12周。采用阳性症状与阴性症状量表 (PANSS)、MorningSide康复状态量表 (MRSS)对患者进行评估。结果 :训练组患者的PANSS评分(3 9 96± 7 44 )、阴性量表总分 (11 92± 5 13 )、一般精神病理量表总分 (2 0 60± 2 95 )优于对照组 (分别为45 77± 8 95、 15 13± 4 79、 2 3 5 0± 5 3 7,P <0 0 5 ) ;训练组患者的MRSS总分 (3 1 60± 17 3 7)、依赖量表总分 (7 2 8± 5 41)、活动能力缺乏量表总分 (9 0 8± 5 5 2 )均优于对照组 (分别为 44 68± 13 61、 11 77± 5 17、15 0 0± 4 48) ;训练组的复发率 (4 % )低于对照组 (17% ) ,但差异无显著性。结论 :在药物治疗的基础上 ,重返社区技能训练能改善精神分裂症患者的症状及其社会功能     

Community participation in primary health care (PHC) programmes: lessons from tuberculosis treatment delivery in South Africa

Background

Currently, there is renewed interest in the role community participation can play in Primary Health Care (PHC) programmes such as the delivery of effective anti-TB treatment to patients in high-burden settings.

Objectives

To explore the feasibility of community participation in a high-burden Tuberculosis Control Programme and to establish how supervision of treatment by lay volunteers compares with other methods of tuberculosis treatment delivery in the Northern Cape province of South Africa.

Methods

Prospective study involving 769 patients with confirmed pulmonary TB who were followed-up over a one-year period. Questionnaire interviews were also carried out with 135 lay volunteers participating in the TB programme.

Results

One-third of the TB patients in the study received their treatment from lay volunteers in the community. Treatment outcomes for new patients supervised from the community were found to be equivalent to those who received treatment through other modes of treatment delivery (RR=1.04[0.94–1.16], p=0.435). For the re-treatment patients, community-based treatment was found to be superior (RR=5.89[2.30–15.09], p<0.001), to self-administered therapy.

Conclusions

Health care planners should consider community participation as a viable way of ensuring accessibility and effectiveness in PHC programmes. There is need for more research into ways of achieving sustainability in resource-limited but high disease burden settings.     

老年抑郁障碍患者的心理干预对比分析

目的 :探讨老年抑郁障碍心理干预的效果。方法 :采用对比研究的方法 ,在流行病学调查的基础上选择符合CCMD -Ⅱ -R诊断标准的 72例抑郁性神经症和 10例抑郁症患者 ,按性别、年龄、文化等基本相同 ,分成对照和实验组各一半 ,实验组给以 6周的心理干预 ,两组均不用药物治疗 ,分别于治疗前及三个月后 ,测评老年抑郁量表、生活满意度指数及社会支持评定量表 ,并进行对比分析。结果 :心理干预前两组老年抑郁量表 (SDS)得分分别为 17 41± 3 19、 17 5 1± 2 44,三个月后对照组下降不显著 ,而实验组明显下降 ( 17 5 1± 2 44/ 8 93± 5 5 2 ,t=10 89,P <0 0 0 1) ;生活满意度 (t=4 33,P <0 0 0 1)实验组显著提高 ;对照组无明显变化 ,社会支持评定实验组 ( 31 15± 6 37/ 36 32± 6 86 ,t =4 93,P <0 0 0 1)也显著提高 ,而对照组则不明显。结论 :社区综合性心理干预可改变抑郁性神经症患者的抑郁情绪 ,改善认知水平 ,从而提高生活满意度。     

我院基于XML异构数据集成的开发应用及研究

基于XML的数据集成，Web Services中间件能够较容易地实现对各数据源的描述以及数据源之间的数据转换，它在应用程序和数据库之间起着接口的作用．本文结合实际医院信息工作，运用VFP9 COM模型，作了有效性的研究及应用，并对标准数据集的二次开发进行了讨论。结果表明，该方法用于医院跨网络平台、跨应用系统、异构信息集成是有效的和易于操作的。     

Molecular epidemiological and clinical aspects of hepatitis D virus in a unique triple hepatitis viruses (B,C, D) endemic community in Taiwan

The molecular epidemiological and clinical aspects of hepatitis D virus (HDV) in a unique HBV, HCV, and HDV triple virus endemic community in southern Taiwan were investigated. A total of 2,909 residents aged 45 or older were screened for hepatitis B surface antigen (HBsAg), anti-HCV antibody, and anti-HDV antibody (specifically for HBsAg-positive carriers). Factors that might be associated with HDV infection, viral nucleic acid detection, and genotyping of HBV, HCV, and HDV were investigated. The prevalence of HBsAg and anti-HCV were 12.6% (366/2,909) and 41.6% (1,227/2,909), respectively. For HBsAg carriers, 15.3% (56/366) were positive for anti-HDV assay. Living in a higher endemic district of HCV infection (odds ratio [OR] = 3.2; 95% confidence interval [CI] = 1.7-6.3), male gender (OR = 1.9; 95% CI = 1.1-3.6) and co-infection with HCV (OR = 1.8; 95% CI = 1.0-3.3) were significantly independent factors associated with HDV infection. The detection rate of HDV RNA among anti-HDV-positive patients was only 12.7% (7/55). The mean HBV titer of triple infection group was significantly lower than in the HBV/HDV co-infection group (2.23 vs 3.05 in log(10), copies/ml, P = 0.046). HCV RNA detection among the triple infection group showed 47.4% (9/19) viremia rate and viral loads of 579,121 IU/ml in median (16,803-1,551,190 IU/ml). The prevalent genotype of HBV was type B (23/25); HCV was 1b (7/9) and HDV was IIa/IIb (4/4). Only the presence of HCV RNA predicted the presence of elevated ALT significantly (OR = 25.0; 95% CI = 3.39-184.6). In conclusion, the geographical aggregation of HDV infection paralleled that of HCV infection in this community. HCV suppressed the replication of HBV among triple vital infection patients. HBV and HDV lapsed into a remission or nonreplicative phase in most cases, and HCV acted as a dominant factor in triple viral-infected individuals. Only the presence of HCV RNA was associated with elevated ALT values, but not HBV or HDV.     

中国社区老年人营养风险检出率的Meta分析

目的 系统评价中国社区老年人营养风险检出率。方法 计算机检索CNKI、CBM、WanFang Data、VIP、PubMed、EMbase、The Cochrane Library、Web of Science、CINAHL数据库有关于中国社区老年人营养状况的研究,检索时限均为2000年1月1日至2021年9月。由2名研究者独立筛选文献、提取资料并对纳入研究进行偏倚风险评价后,采用Stata 14.0软件进行Meta分析。结果 共纳入47个研究,包含47508例老年人,共16923例老年人检出营养风险。Meta分析结果显示,中国社区老年人的营养风险检出率为36.6%［95%CI(30.4%~42.8%)］。亚组分析结果显示,女性44.6%［95%CI(32.4%~56.9%)］、高龄46.8%［95%CI(31.0%~62.5%)］、低文化程度54.8%［95%CI(40.8%~68.8%)］、独居49.7%［95%CI(38.7%~60.6%)］、伴慢性疾病39.0%［95%CI(31.1%~46.8%)］、居住地农村51.8%［95%CI(30.3%~73.4%)］、华中地区56.7%［95%CI(27.5%~85.9%)］、ADL受损70.6%［95%CI(57.0%~84.1%)］、认知功能障碍62.6%［95%CI(38.8%~86.5%)］和衰弱52.6%［95%CI(31.7%~73.6%)］的社区老年人营养风险检出率更高。结论 当前证据显示,我国社区居家老年人营养风险检出率较高,针对检出率较高的特征人群应尽早进行筛查、诊断和干预,减少社区老年人营养风险的发生。     

Difficulties in navigating the intersection of generalist and specialist palliative care services: A cross-sectional study of bereaved family's experiences of care at home in New Zealand

A generalist–specialist model of palliative care is well established as a framework for the provision of community care in resource-rich countries. However, evidence is lacking regarding how the model is experienced by family carers and the extent to which access to both generalist and specialist palliative care is equitable. A cross-sectional postal survey was undertaken to explore bereaved family's experiences of generalist palliative care and its intersection with hospice services in the last 3 months of life. A modified version of the Views of Informal Carers—Evaluation of Services survey was sent to 4,778 bereaved family. Data were collected between February 2017 and October 2018. Chi-square was utilised to identify factors that impacted on experiences of generalist palliative care; analysis of free text data comprising 45,823 words was undertaken using a directed content analysis approach. Eight hundred and twenty-six questionnaires were returned (response rate = 21%). Seventy per cent of people (n = 579) spent some time at home in the last 3 months prior to death. People who received support from hospice were more likely to receive support from multiple other services. Those who received no community services were less likely to feel supported by their general practitioner, less likely to spend the last 2 days of life or die at home. Feeling supported had a strong association with services working well together, being involved in decision-making and being aware of the poor prognosis. The provision of palliative care is complicated by a lack of integration with specialist palliative care and may be the basis of continuing inequities in the provision of community care at the end of life. The assumption at a policy level that “generalists” are willing and able to play a key role in palliative care provision needs to be further challenged.     

Specifics of chronic fatigue syndrome coping strategies identified in a French flash survey during the COVID-19 containment

The COVID-19 pandemic has focused health systems on supporting patients affected by this virus. Meanwhile in the community, many other contained patients could only use self-care strategies, especially in countries that have set up a long and strict containment such as France. The study aimed to compare coping strategies deployed by patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS; a poorly recognised syndrome) to those with better known and referenced chronic conditions. An online flash survey was conducted during the containment period in partnership with French Patients Organizations including ME/CFS national association. Therefore, ‘Brief COPE’ version of Lazarus and Folkman's Ways of Coping Check List has been adapted to the specificity of the containment. The survey was e-distributed in France from 15 April to 11 May 2020. Differences of coping strategies were analyzed using Wilcoxon–Mann–Withney test. Amongst 637 responses, 192 were complete, presenting a wide variety of diseases, including 93 ME/CFS. The latter have significantly different coping strategies than recognised diagnosed diseases patients: similar uses of emotion focused coping but less uses of seek social support and problem-focused copings. In conclusion, coping strategies are different for those who deal with the daily experience of ME/CFS, highly disabling chronic condition with diagnostic ambiguity, low degree of medical and social recognition and without treatment. Better understanding of those strategies is needed to provide the means for health promotion researchers, managers and clinicians, to accompany those patients.     

Relational continuity of care in community pharmacy: A systematic review

Relational continuity of care (COC) is becoming an important concept related to improving healthcare quality, reducing medical costs and increasing patient satisfaction with primary care. While community pharmacy (CP) has a considerable role in primary care, there are few reports dedicated to the role of relational COC in CP. This study reviewed the existing evidence of relational COC in CP and its effect on patients. PubMed, Embase, CINAHL, Cochrane Library CENTRAL and Google Scholar were used to search for relevant studies from the date of database inception through to January 2021, which were appraised according to eligibility criteria. There were no limitations on the primary outcome or language. Case reports and studies without control groups were excluded. The Newcastle–Ottawa quality assessment scale was used to assess the quality of the studies. Database searches identified 13 records. Relational COC measures in the included studies were grouped in three kinds; pharmacy-visiting pattern, Continuity of Care Index and loyalty. The assessed outcomes were medication adherence behaviour (e.g., the proportion of days covered, medication possession ratio), adverse drug reactions, potentially inappropriate drug prescribing and clinical outcomes. The odds of patients adhering to their medication regimen were about 1.1~2.5 times higher among those who consistently visited a single pharmacy compared to patients visiting multiple pharmacies. Additionally, the care provision with a high level of relational continuity could lower inappropriate drug use by 21~32 per cent and the use of other costly services by 12~29 per cent. This study suggests that a high degree of relational COC in CP could improve safe use of medications among patients. Future research is needed to employ more rigorous methods to reduce heterogeneity and to measure effects on clinical outcomes.